Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas

Objective It is well known that parent/patient education helps to reduce the burden of asthma in urban areas, but data are scarce for rural areas. This study explored the impact of asthma education in Ector County, a rural part of Health Services Region 9 in Texas, which has one of the highest prevalence rates of asthma in the state. Methods This prospective study investigated an interactive asthma education intervention in pediatric patients aged 2–18 years and their caregivers. Change in parental/caregiver knowledge about their child’s asthma along with frequency of missed school days, emergency department (ED) visits and hospital admissions was obtained via telephone surveys before and after the educational intervention was delivered. Results The study enrolled 102 pediatric patients and their parents/caregivers. Asthma education was associated with significantly fewer school absences, ED visits and hospitalizations. Parents/caregivers reported feeling better educated, knowing what triggers an asthma exacerbation, identifying the signs of a severe asthma attack in their child, feeling confident about managing asthma and feeling that the asthma was under control. Conclusion Asthma education of caregivers and children was associated with better symptom management and fewer acute exacerbations, pointing to the relevance and importance of asthma education among pediatric patients in rural areas.

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The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature

European Journal of Pediatrics ◽

10.1007/s00431-021-04015-0 ◽

2021 ◽

Cited By ~ 1

Author(s):

Matthijs D. Kruizinga ◽

Daphne Peeters ◽

Mirjam van Veen ◽

Marlies van Houten ◽

Jantien Wieringa ◽

...

Keyword(s):

The Netherlands ◽

Hospital Admissions ◽

Clinical Care ◽

Pediatric Emergency ◽

Pediatric Care ◽

Care Utilization ◽

Admission Data ◽

Multicenter Analysis ◽

Ed Visits ◽

The Impact

AbstractThe coronavirus disease 2019 pandemic has enormous impact on society and healthcare. Countries imposed lockdowns, which were followed by a reduction in care utilization. The aims of this study were to quantify the effects of lockdown on pediatric care in the Netherlands, to elucidate the cause of the observed reduction in pediatric emergency department (ED) visits and hospital admissions, and to summarize the literature regarding the effects of lockdown on pediatric care worldwide. ED visits and hospital admission data of 8 general hospitals in the Netherlands between January 2016 and June 2020 were summarized per diagnosis group (communicable infections, noncommunicable infections, (probable) infection-related, and noninfectious). The effects of lockdown were quantified with a linear mixed effects model. A literature review regarding the effect of lockdowns on pediatric clinical care was performed. In total, 126,198 ED visits and 47,648 admissions were registered in the study period. The estimated reduction in general pediatric care was 59% and 56% for ED visits and admissions, respectively. The largest reduction was observed for communicable infections (ED visits: 76%; admissions: 77%), whereas the reduction in noninfectious diagnoses was smaller (ED visits 36%; admissions: 37%). Similar reductions were reported worldwide, with decreases of 30–89% for ED visits and 19–73% for admissions.Conclusion: Pediatric ED utilization and hospitalization during lockdown were decreased in the Netherlands and other countries, which can largely be attributed to a decrease in communicable infectious diseases. Care utilization for other conditions was decreased as well, which may indicate that care avoidance during a pandemic is significant. What is Known:• The COVID-19 pandemic had enormous impact on society.• Countries imposed lockdowns to curb transmission rates, which were followed by a reduction in care utilization worldwide. What is New:• The Dutch lockdown caused a significant decrease in pediatric ED utilization and hospitalization, especially in ED visits and hospital admissions because of infections that were not caused by SARS-CoV-2.• Care utilization for noninfectious diagnoses was decreased as well, which may indicate that pediatric care avoidance during a pandemic is significant.

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Impact of adenotonsillectomy on the quality of life of patients operated on at the Hospital de Clínicas, Paraguay

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.v8i4.1650 ◽

2021 ◽

pp. 1-7

Author(s):

Carlos Mena Canata ◽

Rebeca Noemí Ruiz Vallejos

Keyword(s):

Quality Of Life ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Rural Areas ◽

Urban Areas ◽

Obstructive Sleep ◽

Significant Difference ◽

Before And After ◽

The Impact

The objective of this study is to determine the impact of adenotonsillectomy on the quality of life of postoperative patients.The study is observational, cross-sectional, and retrospective. The files of all postoperative adenotonsillectomy patients in Otorhinolaryngology Service, Hospital de Clínicas, San Lorenzo Paraguay. The Obstructive sleep apnea – 18 questionnaire (OSA 18) was applied, asking patients about symptoms before and after surgery. An effective sample of 143 postoperative patients was obtained. The average age was 6.05 ± 2.08 years, 55.10% (81) were male and 44.89% (66) were female, 65.30% (96) were from urban areas and 34.69% (51) from the rural areas. The t test was performed for means of two paired samples, comparing the results of the Obstructive sleep apnea – 18 questionnaire surveys before and after surgery which presented a significant difference (p <0.05) with a tendency to improve the quality of life after surgery. It has been shown that there is a significant difference, a considerable improvement in the quality of life of patients after adenotonsillectomy.

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3247 Implementing an Interdisciplinary, Student-Run Consult Service for Homeless Patients: The Critical Role of Community Partnerships

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.210 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 91-91

Author(s):

Frances Loretta Gill

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Hospital Admissions ◽

Community Partnerships ◽

Care Utilization ◽

Consult Service ◽

Utilization Patterns ◽

Ed Visits ◽

Hospital Days ◽

The Impact

OBJECTIVES/SPECIFIC AIMS: Elucidate the unique challenges associated with hospital discharge planning for patients experiencing homelessness. Assess the impact of robust community partnerships and strong referral pathways on participating patients’ health care utilization patterns in an interdisciplinary, student-run hospital consult service for patients experiencing homelessness. Identify factors (both patient-level and intervention-level) that are associated with successful warm hand-offs to outside social agencies at discharge. METHODS/STUDY POPULATION: To assess the impact of participation in HHL on patients’ health care utilization, we conducted a medical records review using the hospital’s electronic medical record system comparing patients’ health care utilization patterns during the nine months pre- and post- HHL intervention. Utilization metrics included number of ED visits and hospital admissions, number of hospital days, 30-day hospital readmissions, total hospital costs, and follow-up appointment attendance rates, as well as percentage of warm hand-offs to community-based organizations upon discharge. Additionally, we collected data regarding patient demographics, duration of homelessness, and characteristics of homelessness (primarily sheltered versus primarily unsheltered, street homeless versus couch surfing, etc) and intervention outcome data (i.e. percentage of warm hand-offs). This study was reviewed and approved by the Tulane University Institutional Review Board and the University Medical Center Research Review Committee. RESULTS/ANTICIPATED RESULTS: For the first 41 patients who have been enrolled in HHL, participation in HHL is associated with a statistically significant decrease in hospital admissions by 49.4% (p < 0.01) and hospital days by 47.7% (p < 0.01). However, the intervention is associated with a slight, although not statistically significant, increase in emergency department visits. Additionally, we have successfully accomplished warm hand-offs at discharge for 71% percent of these patients. Over the next year, many more patients will be enrolled in HHL, which will permit a more finely grained assessment to determine which aspects of the HHL intervention are most successful in facilitating warm hand-offs and decreased health care utilization amongst patients experiencing homelessness. DISCUSSION/SIGNIFICANCE OF IMPACT: Providing care to patients experiencing homelessness involves working within complex social problems that cannot be adequately addressed in a hospital setting. This is best accomplished with an interdisciplinary team that extends the care continuum beyond hospital walls. The HHL program coordinators believe that ED visits amongst HHL patients and percentage of warm hand-offs are closely related outcomes. If we are able to facilitate a higher percentage of warm hand-offs to supportive social service agencies, we may be able to decrease patient reliance on the emergency department as a source of health care, meals, and warmth. Identifying the factors associated with successful warm hand-offs upon discharge from the hospital may assist us in building on the HHL program’s initial successes to further decrease health care utilization while offering increased interdisciplinary educational opportunities for medical students.

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National trends in emergency department closures, mergers, and utilization, 2005-2015

PLoS ONE ◽

10.1371/journal.pone.0251729 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251729

Author(s):

Arjun K. Venkatesh ◽

Alexander Janke ◽

Craig Rothenberg ◽

Edwin Chan ◽

Robert D. Becher

Keyword(s):

Emergency Department ◽

Rural Areas ◽

Urban Areas ◽

Hospital Admissions ◽

The United States ◽

Relative Increase ◽

American Hospital ◽

American Hospital Association ◽

Hospital Bed ◽

Ed Visits

Study objectives To describe nationwide hospital-based emergency department (ED) closures and mergers, as well as the utilization of emergency departments and inpatient beds, over time and across varying geographic areas in the United States. Methods Observational analysis of the American Hospital Association (AHA) Annual Survey from 2005 to 2015. Primary outcomes were hospital-based ED closure and merger. Secondary outcomes were yearly ED visits per hospital-based ED and yearly hospital admissions per hospital bed. Results The total number of hospital-based EDs decreased from 4,500 in 2005 to 4,460 in 2015, with 200 closures, 138 mergers, and 160 new hospital-based EDs. While yearly ED visits per hospital-based ED exhibited a 28.6% relative increase (from 25,083 to 32,248), yearly hospital admissions per hospital bed had a 3.3% relative increase (from 45.4 to 43.9) from 2005 to 2015. The number of hospital admissions and hospital beds did not change significantly in urban areas and declined in rural areas. ED visits grew more uniformly across urban and rural areas. Conclusions The number of hospital-based ED closures is small when accounting for mergers, but occurs as many more patients are presenting to a stable number of EDs in larger health systems, though rural areas may differentially affected. EDs were managing accelerating patient volumes alongside stagnant inpatient bed capacity.

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Rural and Indigenous Health Disparity in Medical Service Use for Dementia and Diabetes Mellitus in Minnesota

Innovation in Aging ◽

10.1093/geroni/igaa057.829 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 258-258

Author(s):

Sung Han Rhew ◽

Patrick Bright ◽

Andrine Lemieux ◽

Wayne Warry ◽

Kristen Jacklin

Keyword(s):

Diabetes Mellitus ◽

Hospital Admission ◽

Rural Areas ◽

Service Use ◽

Hospital Admissions ◽

Indigenous Health ◽

Metropolitan Region ◽

Care Utilization ◽

Urban Regions ◽

Ed Visits

Abstract Minnesota has shown relatively high growth of mortality from diabetes mellitus (DM) and dementia in recent years, especially in rural areas. Analysis of medical care utilization patterns may reveal the reasons for this trend. The goal of the present study was to characterize the Minnesota dementia and diabetes care landscape by rurality and geographic region. Specifically, we compared the Metro region to five other rural-urban regions. Disease-specific 2017 hospital admission and emergency department (ED) visit data was obtained from the State Center for Health Statistics and the Healthcare Cost and Utilization Project. We used the logistic regression analysis adjusted by multiple covariates to evaluate rural-urban differences in hospital admissions and ED visits. Age-adjusted rates of ED visits for both DM and dementia were significantly higher in rural zip code areas, especially in northeast regions. Rural areas had elevated odds for dementia hospital admissions (OR=1.05, p<0.0001) and ED visits (OR=1.24, p<0.0001), but decreased odds for DM hospital admission (OR=0.96, p<0.0001) and ED visits (OR=0.96, p<0.0001). This was particularly true in the northeast region (relative to Metro regions) where ED visits were less likely due to DM (OR=0.89, p<0.0001) but more likely related to dementia (ORs=1.42, p<0.0001). Geographic differences for ED visits due to DM were greater than those for dementia, with higher rates for rural as compared to urban regions (northeast MN compared to a large metropolitan region). This geographical mismatch between mortality rates and ED visit rates may illustrate the relative lack of access to health services in rural MN.

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Impact of Elected Women Representatives of Panchayati Raj in Physical and Financial and Business Assets Development of Rural Women: A Study among the Rural Women’s of Tiruvannamalai District, Tamil Nadu[1]

Scholarly Research Journal for Humanity Science & English Language ◽

10.21922/srjhsel.v4i24.10323 ◽

2017 ◽

Vol 4 (24) ◽

Author(s):

Kalaichelvi Sivaraman ◽

Rengasamy Stalin

Keyword(s):

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Direct Democracy ◽

Tamil Nadu ◽

Local Level ◽

Rural And Urban Areas ◽

The Government ◽

The Impact ◽

Panchayati Raj

This research paper is the part of Research Project entitled “Impact of Elected Women Representatives in the Life and Livelihood of the Women in Rural Areas: With Special Reference to Tiruvannamalai District, Tamil Nadu” funded by University of Madras under UGC-UPE Scheme.The 73rd and 74th amendments of the Constitution of India were made by the government to strengthen the position of women and to create a local-level legal foundation for direct democracy for women in both rural and urban areas. The representation for women in local bodies through reservation policies amendment in Constitution of India has stimulated the political participation of women in rural areas. However, when it’s comes to the argument of whether the women reservation in Panchayati Raj helps or benefits to the life and livelihood development of women as a group? The answer is hypothetical because the studies related to the impact of women representatives of Panchayati Raj in the life and livelihood development of women was very less. Therefore, to fill the gap in existing literature, the present study was conducted among the rural women of Tiruvannamalai district to assess the impact of elected women representatives in the physical and financial and business development of the women in rural areas. The findings revealed that during the last five years because of the women representation in their village Panjayati Raj, the Physical Asset of the rural women were increased or developed moderately (55.8%) and Highly (23.4%) and the Financial and Business Asset of the rural women were increased or developed moderately (60.4%) and Highly (18.7%).

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Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01779-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Antonio Leon-Justel ◽

Jose I. Morgado Garcia-Polavieja ◽

Ana Isabel Alvarez-Rios ◽

Francisco Jose Caro Fernandez ◽

Pedro Agustin Pajaro Merino ◽

...

Keyword(s):

Heart Failure ◽

Hospital Admissions ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Secondary Outcome ◽

Ventricular Ejection Fraction ◽

Number Of Patients ◽

Ed Visits ◽

The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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Impact of Monovalent Rotavirus Vaccine on Rotavirus Hospitalizations among Children Younger Than 5 Years of Age in the Ouest and Artibonite Departments, Haiti, 2013 to 2019

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0414 ◽

2021 ◽

Author(s):

Anne-Marie Desormeaux ◽

Eleanor Burnett ◽

Gérard Joseph ◽

Mentor Ali Ber Lucien ◽

Negar Aliabadi ◽

...

Keyword(s):

Negative Binomial ◽

Hospital Admissions ◽

Absolute Number ◽

Sensitivity Analyses ◽

Rotavirus Vaccine ◽

Vaccine Introduction ◽

Rotavirus Vaccination ◽

Before And After ◽

Rotavirus Diarrhea ◽

The Impact

Rotavirus is responsible for 26% of diarrheal deaths in Latin America and the Caribbean. Haiti introduced the monovalent rotavirus vaccine in April 2014. The objective of this analysis is to describe the impact of the rotavirus vaccine on hospitalizations among Haitian children younger than 5 years old during the first 5 years after introduction. This analysis includes all children with diarrhea who were enrolled as part of a sentinel surveillance system at two hospitals from May 2013 to April 2019. We compare the proportion of rotavirus-positive specimens in each post-vaccine introduction year to the pre-vaccine period. To account for the potential dilution of the proportion of rotavirus-positive specimens from a waning cholera outbreak, we also analyzed annual trends in the absolute number of positive stools, fit a two-component finite-mixture model to the negative specimens, and fit a negative binomial time series model to the pre-vaccine rotavirus-positive specimens to predict the number of rotavirus diarrhea hospital admissions in the absence of rotavirus vaccination. The overall percentage of rotavirus-positive specimens declined by 22% the first year after introduction, increased by 17% the second year, and declined by 33% to 50% the subsequent 3 years. All sensitivity analyses confirmed an overall decline. We observed a clear annual rotavirus seasonality before and after vaccine introduction, with the greatest activity in December through April, and a biennial pattern, with high sharp peaks and flatter longer periods of increased rotavirus activity in alternating years, consistent with suboptimal vaccination coverage. Overall, our study shows evidence that the introduction of the rotavirus vaccine reduced the burden of severe rotavirus diarrhea.

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IMPACT OF DIGITAL MARKETING: THE PRESENT SCENARIO IN TELANGANA STATE – AN EMPERICAL STUDY

Scholarly Research Journal for Interdisciplinary Studies ◽

10.21922/srjis.v8i65.1575 ◽

2021 ◽

Vol 8 (65) ◽

pp. 15164-15172

Author(s):

S. Pratap ◽

Aziz Fatima

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Digital Marketing ◽

Rural And Remote ◽

Remote Areas ◽

Wide Range ◽

Rural And Remote Areas ◽

Telangana State ◽

The Impact ◽

Made In

In present scenario of COVID-19, the effect of pandemic on Digital Marketing is visible not only in urban areas but also in rural areas. Customers are searching for various products and services through Google by which they can purchase wide range of products and services to fill their needs and desires at relatively low price. The freedom to select numerous products is available by browsing various websites. Hence this study focuses on Impact of digital marketing particularly in the selected rural areas of Telangana state. This state been formed recently but in the IT sector it is receiving much attention throughout the globe, as many MNC’s are establishing their operations in this state. Therefore, an attempt has been made in this study to find out how the Impact of digital marketing is trickling down in the rural and remote areas of newly formed Telangana state. Hence this study focuses the impact of digital marketing in the selected areas of Telangana state.

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